18316 POST THIS CARD'NEAR FRONT OF BUILDING RmITNUM R
:• `N CITX OF 'CUPERTINO . 1 $316
IP4SPECTJON DIVISION `
JOB INSPECTION REP-ORD
�y
" Ar, •� ..PERMIT EXPIRATION
-JOB ADDRESS 'NfT LOT.# � C''�' J .� �
" ''nn - 41s -N- OT
4EdMIY!EXPIRESIF WO K
owNER, '- We S (� CONTRACTOR V !c D ej,' , STARTED WI IN
INSPECTION DATE INSPECTOR INSPECTION RECORD ' ieo Dnvs OF PERMIY."il
FOUNDATION r - _ 'ANCE OR IBO DAYS FROM
NOTE: ' LAST CALLED INSPECTION. .
LIFER ALL GRADING AND DRAINAGE SHALL'BE INSTALLED
PREGUNITE TO COMPLY WITH THE APIFI�OVEOIPLANS AND CITY OF PERMFI VALIDATION
CUPERTINO STANDARDS. YY fN^ti144LL''
GARAGE SLABS - *^ „� "��•'C"
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND /SL^ABi moi '
V y,'rG�/t,JL�;
PLUMBING - - _ _ � ,//
ELECTRICAL I ISSUANCE UA ,4 v
MECHANICAL "- - - BLDG. ELECT, PLc. MECR,
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDwc PERMIT
INFORMATION
PLUMBING WOOD FLOOR I VALUATION PLUMBING
/f
. MECHANICAL
ELECTRICAL
PERM T TO
" � - rr ~
FRAMING •
STORIES TYPE CONSTR
INSULATION - - a "-
w - OCC,OROUP RES UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED "
ROOF" NOTE:NO FINAL INSP.SHALL BE MADE BEFORE so IT EL ARIA TornL ACREAGE
DIAPHRAGM THE CONSTRUCTION TAX IS PAID
BUILDING USE
ROOF SHEATHING RES No CON PB 0m1•1
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. •: . ❑ ❑ ❑ ❑ ❑
a ASSESSORS PARCEL NO
ROUGH SAN.#
PLUMBING - ELECT.'ENERGY _ — L
TRACT NO. PARCEL NO
TUBS&SHOWER PAN' PLUMBING ENERGY'.
MECHANICAL - MECH.ENERGY
ELECTRICAL - BUILDING ENERGY ', ACC DATE , ACC.FILE No..
FRAMING,' ELECT,FINAL TEST zowmc ENG SITE No..
` INSULATION - PLUMBING
GAS TEST GAS
MECHANICAL - FIRE SPRINK - ENERGY T.d4
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING Y ❑ .N❑ I Y ❑. N❑
„ FLOOD ZONE A.L.UL.
EXTERIOR SHEAR ELECTRICAL RELEASE ❑. -
Y .NO Y ❑ N[:]" .
- INTERIOR SHEAR - � FIRE DEPT: � ,�•,'
SHEETROCK' - e • GRADE FEE SUMMARY
EXTERIOR LATHBUILDING1 RBUILDING
" INTERIOR�LATH, - TEMPORARY APPROVALS
SCRATCH COAT - ELECTRIC PLAN CHECK
. . GAS FEE . .
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED IOCCUPANCY. SEISMIC FEE ( '
OCCUPANCY OF,BUILDING IS NOT PERMITTED UN TI L BUILDING FINAL IS SIGNED BY BUILDING INSPECTOR. MICROFILM
�.
ARRANGE FOR INSPECTION BY PHONING 252.4505; ELECTRIC
•� HD' ONE WORKING DAY BEFORE REQUIRED INSPECTION: PLUMBING
Z
�: PLEASE GIVE.JOB'ADDRESS WHEN PHONING.- . .
— SEE,PERMIT FOR EXPIRATION'DATE =. MECHANICAL
CONST.TAX
IMPORTANT!" .
PLEASE READ REVERSE SIDE BEFORE
CALLING FOR FINAL INSPECTION. - TOTAL,
OFFICE COPY
CITY OF CUPERTINO
CERTIFICATE OF COMPLETOOIN
BUILDING INSPECTOR'S OFFICE
Date ...... .....1A...........1 19� Building Permit No.
............
The Building Locat d at 161.2 ;�— . ... �
..2...a.........
Owned by A�
k,6 N3
...............................................
ompleTeZF
Has Been mp'e'-" For Use As: ............
0�) ..............................................................
"C
(Alte,e .......
. ...............
.............
.........................................................................................................................................
.............................................................................................................................................
PD-7 ............
BUILDING INSPECTOR
APPLICANT TO FILL IN INFORMATION WITHIN RED,LINES — USE BALL.POINT PEN ONLY
.�., �;•- ' BUILDING PROJECT IDENTIFICATION ` • PERMIT NUMBER
u7,"ADDREss 2072 APPLICATION& PERMIT
ff4SJJ/0N AAX_ BUILDING —ELECTRICAL—PLUMBING—MECHANICAL b
O W NEH'S
NAME f'ASlIION _ 1 PLAN CHECK VALIDATION
- DTV. ELECTRIC PERMIT •FEE I
PHDNE
coNTRAcrons OUTLETS-SWITCHES-RECEP 10.00/1.00
NAME TvFo 1�SSf'1CI R'TtS 1
uc.NO JrOGo53`L LIGHTING FIXTURES 10.00/1.00 I S'IONTR
ADDREACTOg, 4
ApooREss/-�r�,�p, /�O�'/, I�(yQ ��( APPLIANCES-RESIDENTIAL 4.06' ,
SANCM+aD$ .�--A-�- PHON PANELS .10.00 DATE OF APPLICATION
ARCHITECT PLAN CHECK FEE P.C.AO.
OR PANELS (OVER 200 AMP) 20.00
ENGINEER /,I' OP/�
Q'Y SITRANS, 3.00
AENG,'
ADDRESS DRESa SPGNS ECIAL CIRCUIT - „5,00 � 'PERMIT VALIDATION
b�7Pnt�
�7 �r��cr /` ��� ' zIPN -EMP.METER OR POLE INS. 20.00
APPLICANT'S
ADDRESS ' MOTORS SEE FEE SCH.
(o =-7 fito recr A0 F SERVICE CHANGE 20.00 r^ `, VLC-
'.02
C-I
l
F o O LICENSED CONTRACTORS DECLARATION '
I.u1 hereby affirm that I am licensed under provisions of Chapter 9
v,< $ (commencing with Section 7000)of Division 3 of the Business and .-ISBUAN CE DAT
r 0 z' Professions Code,and my license is in full torr.Und ffe .g •` BLOG. ELECT. PLG. MECH.
o i o License Class Lis.Number O - ❑ , ❑
_ W H w Date Contractor :n,Fp'
a w u OWNER-BUILDER DECLARATION _ BUILDING PERMIT
0 a - INFORMATION
X 3:LL H 1 hereby affirm that I am exempt from the Contractor's License MISC.— REFER TO ORD
u 0 sc Law for the following reason.(Sec.7031.5,Business and Professions - 'VALUATION .^ $/FT.
L- — PERMIT ISSUANCE 10.00 0/+Y
IS > Cade:Any city or countypair anyll,strureqcture,
pres a rior
to construct,,alsoter, ®D
Q Q Q improve,derr10I1511,Or repair any SlrnCtnrC,pr10!tO IIS ISanllnCe,aISO ELEC.LONTR. LIC.NO.
an requires the applicant for such permit to file a signed statement that - TOTAL PERMIT TO
w C a. he is licensed pursuant to the provisions of the Contractors License �s
H z ¢
Lau,(Chapter 9(commencing with Section 7000)of Division 3 ofthe
B
E i o usiness and Professions Code)or that he is exempt therefrom and DTV. PLUMBING PERMIT FEE
¢ 1- $ the basis for the alleged exemption.Any violation of Section 7031.5 - STORIES TYPE CONSTR.
a3 � by any applicant for a permit subjects the applicant to a civil penalty ALTER-DRAIN VENT-WATER 5.0
of not more than five hundred dollars($50B.): 0
❑ I;as owner at the property,or my employees with wages astheir BACK FLOW PROTECT.DEVICE 4.00 OCC:GROUP RES.UNITS
intended
sole compensation,will(S the work,and the structure is not
intended or offered for sale (Sec. 7044, Business and Professions DRAINS-FLOOR,ROOF,AREA,COND. 5.00
' Code:The Contractor's License Law does not apply to an owner of - '
property who builds or improves thereon,and who does such work FIXTURES-PER TRAP 5.00 so.RT.FLOOR apEA -TOTAL ACREAGE
himself or through his own employees,provided that such improve- / /N`y
meats are not intended or offered for sale.IL-however,the budding GAS-EA.SYSTEM-11 NC.4 OUTLETS 6.00 ID D
or improvement is sold within one year of completion,the owner-
builder will have the burden of proving thus he did not build or inn- GAS,EA.SYSTEM-OVER 4 (EA.) 2.00 BUILDING USE
prove for purpose of sale.). . INDUSTRIAL WASTE INTER. 30.00 RES IND CON PB Oita,
❑ I,as owner of the property,am exclusively contracting with O
licensed contractors to construct the project(See. 7044,Business ,I L'AWN�SPR IN KLERS-1 INC 5 V.B. 6.00 "ASSESSORS PARCEL NO.
El El Q El
and Professions Code.Tire Contractor's License Law does not apply
to an owner of property who.builds or improves thereon,and who LAWN SPRINKLERS-OVER 5(EA.) 1,00
contracts for such projects with a contractors)licensed pursuant to -
the Contractor's License Law. - SEWER-SANITARY-STORM EA.200ft/10.00 TRACT NO. .PARCEL NO.
- '❑ I am exempt .later Sec. ,B.&P.C.far this
reason WATER HEATER W/VENT 6.00
Owner Date WATER SYSTEM - 5.00 ACC.DATE ACC.FILE NO.
WORKERS'COMPENSATION D17CLARA'TION WATER TREATING EQUIP, 5.00
-I hereby affirm that I have a certificate of consent to self-insure,
or a certificate of Workers'Compensation Insurance,or a certified ZONING _ ENG.SITE NO.
copy thereof(Sec.380 .CJ.
Policy N-. 6mp' y
❑ Certd in
is he yfurm c _ FIRE SPRINK ENERGY T-24
Z Z X Certified p Spe MISC.
,P W TF.OF Ble h he c' 1 ion division. Y' N ' v N
0 ' Applicant u :'Gr - REFER TO ORD.
cc CE RTIFI AEXEMPTION FROM WORKERS' PERMIT ISSUANCE 10.00 FLOOD ZONE A.L.U.L.
W COMPENSATION INSURANCE PLG.CONTR. LIC.NO. PLG. '
d (This section need not be completed if the permit is for one TOTAL V�. N� 'Y N
� Z hundred dollars($100)or less.)
4 �'..:Q
w.;
U O I certify that in the t motley an of the work for which this per- QTY. MECHANICAL PERMIT FEE FEE SU WAIRW
0 U mit is issued,1 shall e W employ any person in any manneror as to
become subject to the Workers'Compensation Laws of California.
U y Date Applicant ALTER OR ADD TO MECH. 5.00 BUILDING 22S�uo
�- H NOTICE TO APPLICANT: If,after making this Certificate of Ex-
F ? emption,you should become subject to the Workers Compensation APPLIANCE 5.00 PLAN CHECK
provisions of the Labor Code, you must forthwith comply with U FEE such provisions or this permit shall be deemed revoked " AIR HANDLING (TO 10=r—F.M.) 4.00
CONSTRUCTION LENDING AGENCY AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 SEISMIC FEE 3 Q
I hereby affirm that there is a construction lending agency for EXHAUST HOOD(WITH DUCT) 5.00
the performance of the work for which this permit is issued(Sec. MICROFILM
3097,Civ.C.). HEATING UNIT(TO 100,000 B.T.U.) 8.00
Lender's Name -
Leader'sAddress HEATI NG UN IT(OVER 100,000 B.T.U.)9.50 ELECTRIC
I certify,that I have read this application and slate that the above VENTILATION FAN (SINGLE) 4.00
information is correct. 1 agree to comply with all city and county BOILER-COMP(3 H.P.or 100,000 B.T.U.) 6.00 PLUMBING
ordinances and state laws relating to building construction, and
•� hereby authorize representatives of this city es enter upon the BOILER-COMP(0vnr 100,000STU1 SEE FEE SCH. MECHANICAL
above-mentioned property for representatives
inspection oth purposes.
(We) agree to save, indemnify and keep harmless the City of MISC.- REFER TO ORD. y
upertin0'agagsNtni)ilities,judgments, costs and-expenses which in consequence of the PERMIT ISSUANCE 10.00 CONST.TAX
ay in any Fay ac ue ago' Irt 1
rantingo his per f. l MECH.CONT. LIC.NO. MECH.
m TOTAL TOTAL 29,3
Signa re of Applicant Contrac or
Data
OFFICE COPY